Provider Demographics
NPI:1801883913
Name:KODE SAMMARCO, LAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:KODE SAMMARCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAKSHMI
Other - Middle Name:KODE
Other - Last Name:SAMMARCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4795 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-4119
Mailing Address - Country:US
Mailing Address - Phone:513-213-9330
Mailing Address - Fax:877-766-4557
Practice Address - Street 1:4795 DRAKE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-4119
Practice Address - Country:US
Practice Address - Phone:513-213-9330
Practice Address - Fax:877-766-4557
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350588092085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0229363Medicaid
F86530Medicare UPIN
K04028863Medicare ID - Type Unspecified